Meningitis / meningoencephalitis and meningococcal sepsis

Clinical Features

• Headache
• Fever
• Altered consciousness
• Neck stiffness
• Nausea and vomiting
• Rash*
• Seizures
• Shock 

Suspect Listeria in patients who are immunocompromised, over 50 years old, or peripartum

*Rash can be harder to see on brown or black skin. Check paler areas, such as the palms of the hands, soles of the feet, roof of the mouth, abdomen, whites of the eyes or the inside of the eyelids. 

Investigations

Lumbar puncture

• Bacterial culture
• Viral PCR
• Cell counts / microscopy
• Protein and glucose
• Serum glucose (at the same time as LP) 

Blood culture

Bacterial throat swab

Viral throat swab

Blood (EDTA) for meningococcal PCR

Infection Control

• Isolate
• Droplet precautions
• Fluid resistant surgical facemask for routine care, and FFP3 mask for intubation or other procedures involving airway, until established on appropriate antimicrobial treatment.

Treatment

Consider DEXAMETHASONE (10mg IV QDS for 4 days)  at an early stage for suspected meningitis  See full guidance:  Meningitis Research Foundation guidelines

CEFTRIAXONE (IV)  2g 12 hourly 

If Listeria suspected: add

AMOXICILLIN (IV)  2g 4 hourly

 

If true penicillin allergy (anaphylaxis)

CHLORAMPHENICOL (IV)  25 mg / kg 6 hourly (maximum 2g per dose)

If Listeria suspected and true penicillin allergy (anaphylaxis): add

COTRIMOXAZOLE (IV)  1.44g 12 hourly

Duration: Review at 7 days, or when a pathogen is identified

CEFTRIAXONE is unrestricted for this indication

Obtain travel history and consider adding VANCOMYCIN IV if recently overseas or prolonged / multiple antibiotic exposure in last 3 months

CHLORAMPHENICOL is not routinely available but may be used for this indication. Microbiology must be informed once this has been initiated. 

Contact the Health Protection Team for advice about prophylaxis for community contacts